摘要
[目的]探讨关节镜下清理及应用记忆合金骑缝钉固定的胫骨高位截骨术治疗膝关节骨关节炎的手术方法、手术适应证及疗效。[方法]自1999年3月～2003年5月应用记忆合金骑缝钉固定的胫骨高位截骨术结合关节镜下清理术治疗膝关节骨关节炎34例（42膝），男6例（8膝），女28例（34膝），年龄42～67岁（平均54．2岁）。随访1a4个月～3a8个月（平均2a11个月）：关节镜下发现：髌内侧滑膜皱襞10例；内侧半月板损伤12例；外侧半月板损伤6例；关节软骨损伤20例；关节内游离体7例；髁间窝狭窄9例，关节镜下清理后进行胫骨高位截骨，不显露腓总神经，闭合楔形截骨，行改良胫骨结节前置，保持内侧骨膜的稳定性，应用记忆合金骑缝钉固定。[结果]膝关节疼痛基本消失，关节功能基本不受影响，膝内翻畸形得到矫正：膝关节评分术前为（53.71±6，7），术后为（91．02±7．7），两者比较有显著性差异（P〈0．01），优良率为95．24％。术后并发症少，能早期进行功能锻炼，无需再次取出内固定。[结论]关节镜下清理及应用记忆合金骑缝钉固定的胫骨高位截骨术治疗膝关节骨关节炎，治疗关节内病变，具有操作简便，固定牢固，神经、血管损伤发生率低，可早期负重，早期进行功能锻炼，促进骨质愈合，组织相容性好．无须二次手术取出等优点.
[ Objective ] To evaluate the results of treatment with arthroscope and high tibial osteotomy with fixation of staple made of retention alligation for osteoarthritis of the knee, and to discuss the indication for this technique. [ Method] From March 1999 to May 2003, 42 arthroseopie treatment and high tibial osteotomies were performed in 34 patients. There were 6 men （8 knees） and 28 women （34 knees） , with a mean age of 54. 2 years （ranged, 42 -67 years）. The average postoperative follow-up was 36 months （ranged, 16 -44 months）. The indications for high tibial osteteotomy were unieompartmental osteoarthritis and varus malalignment. After arthroscopic treatment, a lateral closing-wedge osteotomy was performed with fixation of staple made of retention alligation. The arthroseopic examination showed： plica synovialis in 10 knees, medial meniscus injuries in 12 knees, lateral meniscus injuries in 6 knees, articular cartilage injuries in 20 knees, body loose in joint in 7 knees, intercondylar fossa stenosis in 9 knees. Common peroneal nerve was not exposed and the periosteum opposite to the insieion position was left intact for sake of stability and acted as a hinge around which the wedge osteotomy was closed. The patients were reexamined to obtain a knee score, to make lateral andanteroposterior radiograph of the involved knee with the patient standing. [ Result] During the follow-up, the patients showed satifying pain relief, improvement of joint function, correction of yams deformity. The average preoperative knee score was 53.714 ±6. 7, The average postoperative knee score at the time of the latest follow-up was 91.02 ± 7.7. Comparing preoperative with postoperative, there were significant differences （P 〈 0. 01 ）. The excellent and good result was 95.24%. Earlier rehabilitation exercise should be carried out and the complication was rare. It is unnecessary to accept another operation to take out of the internal fixation. [ Conclusion ] The advantages of the arthroscopic treatment and hi
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2006年第3期192-195,共4页
Orthopedic Journal of China
关键词
骨关节炎
膝
内固定器
胫骨
骨切开术
Ostenarthritis,knee
lnternal fixators
Osteotomy
Tibia
